NYRA Rewards Application

Personal Information:

*First Name: *Last Name: MI:
*Date of Birth:
*Social Security Number: no dashes

Contact Information:

*Mailing Address: P.O. Box addresses not permitted
*State:      *Zip Code
*Email Address:   required for online wagering
*Confirm Email Address:
Your email address will be used for communication purposes including
statement remittance, racing information and application updates.
*Primary Phone: xxx-xxx-xxxx.
Alternate Phone:

NYRA Rewards User Information:

Select an access code for NYRA Rewards Telephone wagering.
*Access Code: 2 - 8 letters with no Numbers
*Re-enter Access Code:

Select a Pin # for online wagering and on-track self-service terminals. Online wagering is currently available to residents of NY state only.
*Pin #: 4 Numbers with no Letters
*Re-enter Pin #:
Please answer following security questions. These questions have been added for security purposes and will be used to authenticate your identity when changes are requested.
*Security Question #1:
*Answer #1:
*Security Question #2:
*Answer #2:

Click here to see the rules for NYRA Rewards account Wagering.

I hereby request that The New York Racing Association Inc. issue me a NYRA REWARDS account wagering card. In consideration for the issuance of the account card, I agree that I have read, accept, and agree to abide by NYRA's rules and regulations pertaining to the NYRA Rewards program. Moreover, I agree that NYRA will not be responsible to me for funds charged to my account as a result of any unauthorized use of the card and/or Access Code and PIN No. By my signature below, I attest that I am eighteen (18) years or older. Falsifying information on this application can result in criminal prosecution and forfeiture of funds on deposit. I further understand that all winnings subject to reporting and/or withholding as described in IRS form W2G will be administered in accordance with applicable IRS code.

NYRA carefully safeguards our member's privacy and security. Any misuse of accounts, including but not limited to fraudulent or suspicious activity, will be reported to law enforcement agencies.

*Required field